Claims Examiners, Property and Casualty Insurance

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Claims Examiners, Property and Casualty Insurance

Careers / Claims Examiners, Property and Casualty Insurance

Summary Description


	Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures. Report overpayments, underpayments, and other irregularities. Confer with legal counsel on claims requiring litigation.

Sample Job Titles

1.	Case Manager

2.	Casualty Claims Supervisor

3.	Check Examiner

4.	Claim Auditor

5.	Claims Account Manager

6.	Claims Account Specialist

7.	Claims Adjuster

8.	Claims Analyst

9.	Claims Auditor

10.	Claims Consultant

11.	Claims Director

12.	Claims Examiner

13.	Claims Manager

14.	Claims Representative

15.	Claims Specialist

16.	Claims Supervisor

17.	Claims Vice President

18.	Corporate Claims Examiner

19.	Customer Care Specialist

20.	Executive Relations Specialist

21.	Home Office Claim Specialist

22.	Home Office Claims Examiner

23.	Insurance Auditor

24.	Insurance Examiner

25.	Liability Claims Examiner

26.	Liability Claims Manager

27.	Liability Claims Representative

28.	Litigation Examiner

29.	Property Damage Claims Adjustor

30.	Reinsurance Claim Analyst

31.	Worker's Compensation Claims Examiner

32.	Workers Compensation Claims Examiner

33.	Workers Compensation Examiner

Job Tasks

	Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio. Investigate legal issues. Negotiate agreements to resolve disputes.

	Supervise claims adjusters to ensure that adjusters have followed proper methods. Supervise employees.

	Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies. Implement financial decisions. Advise others on financial matters.

	Resolve complex, severe exposure claims, using high service oriented file handling.

	Pay and process claims within designated authority level. Pay charges, fees, or taxes.

	Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. Investigate legal issues.

	Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures. Verify accuracy of records.

	Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation. Maintain data in information systems or databases.

	Confer with legal counsel on claims requiring litigation.

	Conduct detailed bill reviews to implement sound litigation management and expense control. Examine financial records.

	Contact or interview claimants, doctors, medical specialists, or employers to get additional information. Interview witnesses, suspects, or claimants.

	Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis. Prepare financial documents.

	Report overpayments, underpayments, and other irregularities. Report information to managers or other personnel.

	Present cases and participate in their discussion at claim committee meetings. Present business-related information to audiences.

	Communicate with reinsurance brokers to obtain information necessary for processing claims. Confer with others about financial matters.

	Prepare reports to be submitted to company's data processing department. Prepare operational reports.

Work Activities

Importance	Work Activity

Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources.

Resolving Conflicts and Negotiating with Others — Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.

Interacting With Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.

Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.

Identifying Objects, Actions, and Events — Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.

Evaluating Information to Determine Compliance with Standards — Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.

Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.

Processing Information — Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.

Documenting/Recording Information — Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.

Organizing, Planning, and Prioritizing Work — Developing specific goals and plans to prioritize, organize, and accomplish your work.

Communicating with Persons Outside Organization — Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.

Monitor Processes, Materials, or Surroundings — Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.

Updating and Using Relevant Knowledge — Keeping up-to-date technically and applying new knowledge to your job.

Establishing and Maintaining Interpersonal Relationships — Developing constructive and cooperative working relationships with others, and maintaining them over time.

Analyzing Data or Information — Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.

Performing for or Working Directly with the Public — Performing for people or dealing directly with the public. This includes serving customers in restaurants and stores, and receiving clients or guests.

Interpreting the Meaning of Information for Others — Translating or explaining what information means and how it can be used.

Thinking Creatively — Developing, designing, or creating new applications, ideas, relationships, systems, or products, including artistic contributions.

Judging the Qualities of Things, Services, or People — Assessing the value, importance, or quality of things or people.

Performing Administrative Activities — Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.

Developing Objectives and Strategies — Establishing long-range objectives and specifying the strategies and actions to achieve them.

Inspecting Equipment, Structures, or Material — Inspecting equipment, structures, or materials to identify the cause of errors or other problems or defects.

Estimating the Quantifiable Characteristics of Products, Events, or Information — Estimating sizes, distances, and quantities; or determining time, costs, resources, or materials needed to perform a work activity.

Monitoring and Controlling Resources — Monitoring and controlling resources and overseeing the spending of money.

Coordinating the Work and Activities of Others — Getting members of a group to work together to accomplish tasks.

Developing and Building Teams — Encouraging and building mutual trust, respect, and cooperation among team members.

Guiding, Directing, and Motivating Subordinates — Providing guidance and direction to subordinates, including setting performance standards and monitoring performance.

Scheduling Work and Activities — Scheduling events, programs, and activities, as well as the work of others.

Coaching and Developing Others — Identifying the developmental needs of others and coaching, mentoring, or otherwise helping others to improve their knowledge or skills.

Assisting and Caring for Others — Providing personal assistance, medical attention, emotional support, or other personal care to others such as coworkers, customers, or patients.

Training and Teaching Others — Identifying the educational needs of others, developing formal educational or training programs or classes, and teaching or instructing others.

Provide Consultation and Advice to Others — Providing guidance and expert advice to management or other groups on technical, systems-, or process-related topics.

Selling or Influencing Others — Convincing others to buy merchandise/goods or to otherwise change their minds or actions.

Staffing Organizational Units — Recruiting, interviewing, selecting, hiring, and promoting employees in an organization.

Nature of the Work


	(Abstract from Career Articles)

	Claims Adjusters, Appraisers, Examiners, and Investigators
	Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim, and if so, how much.

	Read More >>

Working Conditions


	(Abstract from Career Articles)

	Claims Adjusters, Appraisers, Examiners, and Investigators
	Most claims adjusters, appraisers, examiners, and investigators work full time. They often work outside the office, inspecting properties for which insurance claims have been made, such as damaged buildings and automobiles.

	Read More >>

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Interesting Fact

The first U.S. patent, issued in 1790 to Samuel Hopkins for a potassium compound, was signed by both President George Washington and then Secretary of State Thomas Jefferson.

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